Re-articulating treatment and/as prevention: a complex systems perspective

In the discourse of treatment as prevention (TasP) we’re seeing an initiative to rearticulate the historically separate traditions of HIV treatment and prevention as a single system.

Its starting point is the research finding that people with HIV who have suppressed viral load and no STI co-infection are ‘virtually uninfectious’ to HIV-negative partners, even when condoms are not used.

The word ‘virtual’ is interesting here.  The finding itself is virtual; at first, it was just a fact that can be repeated in discourse.  It didn’t change anything; it describes a situation that already existed.

It will take a concerted effort to bring about changes that will make this fact material, in other words, to see it concretely reflected in the work of prevention and the everyday lives of people living with and at risk of HIV infection.

My current work looks at prevention as an emergent effect of patterns among all those everyday encounters and interactions: in other words, a complex systems perspective.

The systems perspective suggests there are many different paths the rearticulation of systems for treatment and/as prevention could take.  Some of them lead in quite problematic directions, while others may reveal productive and generative possibilities.

Of course, this being a blog about stigma and public health strategy, the primary axis I’m thinking of is HIV stigma and the ‘serodivide’ between positive and negative people in different populations.

Articulation is a useful perspective for thinking through apparent dichotomies.

At the AIDS2014 conference I took part in a video interview by Rex Pilgrim from ACT UP Queensland, offering a critical public health slant on the potentially coercive application of public health power, which many see as a preferable and gentler alternative to crimino-legal responses to HIV transmission.  I don’t actually see that as a choice between alternatives; I see the threat of criminal prosecution as articulated with public health power, as an intensifier of its implied coercive potential.

However, in one of its many different formulations, articulation was seen as the way people and institutions with power take up the concerns of the working class and use them to re-express the agenda of the powerful.

That portrait of power is a bit crude, though.  I did a workshop last week on the systems perspective in which I argued that change ‘management’ is challenging because the status quo is actively and continually being produced by social systems, and this resonated for one stakeholder as a ‘conspiracy theory’ about a powerful Them.

On a complex adaptive systems (Holland 1995; Ostrom 1999) perspective, however, agency itself might be an emergent property of aggregate patterns among interactions on lower levels of social organisation.

That’s an exciting possibility; for instance, it provides an empirically plausible account of the ‘microfoundations‘ (Dan Little’s term) of the Ottawa Charter philosophy of engaging with communities as having agency as communities.

Research by Holland, Kingdon (1984) and more recently the European social theorist Klaus Eder (1999) has examined the way more or less random and recombinatory events in social systems can contribute to social learning at a local level and, when the lessons learned are picked up and transmitted by the nature of those systems, to wide-scale social transformation.

Exactly these processes have been observed in the work of Stephen Lansing on the Subak system for water allocation on the fragile farming ecosystem of Mount Agung in Bali, which originated the world’s oldest and longest functioning democratic culture to facilitate that learning process.

Elinor Ostrom won the Nobel Prize in Economics for developing these findings into a general model of how self-organising human collectives manage to avoid ‘tragedies of the commons’, the bogeyman of classical economics that underpins so many of its arguments in favour of market based ‘cap and trade’ or quota systems.

A key idea in this work is that social units within complex adaptive systems observe the outcomes of new rule combinations in neighbouring terrain and ‘borrow’ the ones that are seen to work.

I’d argue this model applies to policy innovation(s) as well, generally and specifically.  So I was deeply concerned this morning to read this article from St Louis Today, titled ‘2,000 St Louisans are HIV Positive but not taking their medications‘.  It recombines or in other words weaves together strands from an astonishing variety of different memes about HIV prevention.

In particular, it takes the ‘treatment cascade’ concept, created as a complex matrix of targets on the path towards population-level treatment as prevention, and it translates it into an object of media concern, a well-worn step on the pathway towards legislative responses that seek to coerce compliance among people reconfigured as a risk to public health.

Along the way, it treats medical doctors as experts in the social science of prevention.  Many are, but they generally don’t repeat stereotyped ideas such as ‘young people aren’t scared enough’ and ‘African-American men have an element of denial in their sexuality’ (as opposed to the white middle-class ‘masc gay btm’ who just hit on me on Grindr).

The really key problem is the way it translates treatment as prevention into an idea with primarily individual behavioural implications, setting up concern in the community about whether PLHIV are compliant or ‘a risk to others’.

That’s a deeply concerning pathway for the rearticulation of treatment and/as prevention to take.

The countries with the most successful HIV prevention responses are those that enabled communities to educate, resource and support their own people to protect themselves and their partners — what I called community-based prevention responses in my contribution to a 2012 NAPWHA Monograph on criminalisation.

The countries with the least successful HIV prevention responses are those that created punitive laws as ‘incentives’ within that model of classical individual rational choice theory economics that can’t place any trust in altruism.

So far, this discussion has been pretty theoretical, so I want to finish by highlighting two recent attempts to make this stuff concrete and practical.  One was posted today by a friend of mine, Ted Kerr, former convenor of Visual AIDS in New York.  It shows the educational approach that is necessary when public policy does not enable community-based responses.

how to have sex in a police stateThe title bookends the early resource produced by Callen and Berkowitz for gay men, ‘How to have sex in an epidemic: one approach‘, a resource which got some things wrong but most things right, and effectively invented condoms as safe sex, long before researchers were ready to say with confidence that HIV was a virus and sexually transmitted.

It was an act of recombination whose fitness was selected for by reality.  As a colleague of mine, Garrett Prestage, has said, people in the gay community tried it out and they knew it worked when they got tested.

A second highlight is a new resource for people living with HIV published by Living Positive Victoria in partnership with the Victorian AIDS Council, called ‘Talking with your negative friends and partners about PrEP‘.

Screenshot 2015-03-30 15.55.57Full disclosure and/as humblebrag: my new business, DNM Strategic Consulting, developed and focus tested the resource.

It would be problematic if PrEP were only ever marketed to HIV-negative men as a strategy to protect them from PLHIV, so the resource encourages people using or considering PrEP to learn from people living with HIV about taking meds, trusting their GP, dealing with stigma.

Importantly, the resource reflects a different path for the articulation of treatment and/as prevention — integrating new knowledge about the efficacy of HIV medications while strengthening and adding value to the ongoing encounters, interactions and relationships that constitute community among people living with and at risk of HIV in the absence of a vaccine or cure.

Great recent writing about HIV prevention

I’ve been banging on for a while about the way hackneyed story angles and news ‘hooks’ lead to lousy media coverage of emerging issues in HIV prevention.  In this post I want to acknowledge some of the really good writing that has happened in the past few months, all of it in the gay community press.

Three recent pieces

The taboo of barebacking by Rachel Cook

HIV/AIDS has catapulted gay male culture through so many extremes in just a few decades that it is understandable there are those who find the idea that condomless sex could now be permissible confronting. Especially, for some men who for the majority of their sexual lives have been told the only way to protect against HIV transmission is via the use of condoms. Remembering also it was not that long ago that this community was not just decimated by the virus but brutally punished by broader society as well. For a significant proportion of our community, that’s a lot to wade through.  So are gay men ready to accept that condomless sex is a relatively safe option in the right context? 

This piece raises issues that get excluded by overly emotional, sentimental, or moralistic responses to barebacking, and in so doing it enlarges the debate without taking a position on it.  The author, MCV editor Rachel Cook, interviewed exactly the right people for the piece — Kane Race, Nic Holas and Brent Allan — to give a grounded and nuanced picture of the issue.

The new gay sex by Benjamin Riley

In a challenging and controversial essay on PrEP for New York magazine, writer Tim Murphy documented a community divided. On one hand, men who see this as a chance to, for the first time in their lives, have “sex without fear”. On the other, men for whom PrEP connotes new fears — a rise in condomless sex leading to a rise in other STIs, negative perceptions from the straight community, slavery to the pharmaceutical industry, even disrespect for a generation of the dead. While the reality is of course more complex, the extreme views of those living on the poles of the debate have shaped the conversation.

This article is SO GREAT.  I think it highlights the positives in the Star Observer’s shift to a monthly format — it loosens the expectation that a weekly rag will feature short articles with a news hook, which is all too often ‘experts and community members disagree over x’.  The feature length format allows Riley to acknowledge the different views on either side of the pro/anti PrEP debate, while walking readers up to the idea that the reality of PrEP is less black and white.  Riley won the 2014 Media Award at the Victorian AIDS Council AGM and it was really well deserved.

Twenty-five / sixty by Benjamin Riley

Dennis [Altman, interviewed for the piece] argues young gay men today are engaging with the past because they represent a “third generation” — the first gay men with the space to look back. After the activists of the 70s, an entire generation came out during the worst of the AIDS crisis in the 80s and early 90s, defining the way they see themselves.

He adds that for the first time we are seeing a cohort of young gay men who escaped much of the damage of those previous generations, and it could serve as a painful reminder of that damage.

“If we keep saying that social stigma and discrimination causes people to be damaged… then at some point we have to accept that the people who are telling everybody else that they’re damaged may also be damaged themselves,” he says.

“We have to be willing to think, well okay, how’s this affected me, and how much of this am I carrying around?”

This piece could have been such a train wreck, simply repeating tired old generational stereotypes, but as this quote illustrates, Riley got his interviewees to reflect on their own perspectives on the AIDS crisis and our contemporary post-AIDS reality.  To find Dennis Altman being critical is no great surprise, but here he is speaking with compassionate insight about his peers, and instead of calling younger gay men ignorant, he acknowledges they have a historical opportunity to look back… just brilliant.


All three of these pieces come from the gay community media.  It is harder to find articles worth celebrating in the mainstream media.  You might think ‘well we’d hope the gay press would do better’, but, to be honest, the past decade of gay community press coverage of HIV prevention didn’t give much cause for that hope.

In my time working in community prevention, we’d get six hundred words for a launch article we wrote ourselves in exchange for placing an ad buy with a gay rag, and if we were lucky, the editor — invariably a gay man — wouldn’t come out with an editorial excoriating our campaign for acknowledging that unprotected sex happens.

So what’s changed?  Well, Rachel Cook is now the editor of MCV.  In that last decade, it felt to me like lesbian journalists consistently did a better job than gay men at covering what was new in HIV prevention, perhaps because they weren’t personally bound by a culture of cognitive dissonance around sex without condoms.

Second, I’m terrible at guessing ages but I suspect Benjamin Riley is a member of what Altman calls that ‘third generation’ with the space to look back on HIV without the traumatic intrusion of experiences of friends and loved ones dying — the source of the emotional investment that made the bareback backlash so powerful and dangerous.

In my next post I want to reflect on a story I participated in, albeit peripherally, as guest tweeter for a Background Briefing episode on, wait for it, ‘the controversy between medical experts and the gay community around PrEP’.  In the meantime, please feel free to share your thoughts and responses in the comments below, I’d love to hear from you.

Making stories matter

You know how sometimes you read something and it makes the hairs on the back of your neck stand up?

Narratives about identity and experiences are certainly powerful, necessary, therapeutic, and transformative. Yet I’m struck by their limitations. Knowing about someone’s lived experience of mental illness is important but it is a starting place, not the final outcome of advocacy and health promotion efforts. Discrimination still persists within mental health organisations and services who I’m sure have heard all the stories. Key to making stories matter is translating the stories into practices, actions and change at all levels from the individual, community and systems level. The inadequacy or unsustainability of interventions will not shift from stories alone. We must make stories matter.  (emphasis shifted)

Selfies, narcissism and stigma, Natalie Hendry, 21 Oct 2014.

Are sex researchers afraid to get our hands dirty? Sex-positivity and the policy and media discourses.

The left, [George Lakoff] argues, is losing the political argument – every year, it cedes more ground to the right, under the mistaken impression that this will bring everything closer to the centre. In fact, there is no centre: the more progressives capitulate, the more boldly the conservatives express their vision, and the further to the right the mainstream moves. The reason is that conservatives speak from an authentic moral position, and appeal to voters’ values. Liberals try to argue against them using evidence; they are embarrassed by emotionality. (Zoe Williams, The Guardian, 1 Feb 2014)

WILL MCAVOY: If liberals are so smart, why do you lose so goddamn always?  (The Newsroom.)

When I began for the Victorian AIDS Council ten years ago, I got a really thorough apprenticeship in community-based HIV work from my colleagues, Guy Hussey, Tex McKenzie and Asvin Phorugngam.  It was grounded in three main principles:

  • Sex-positivity
  • Adult learning principles
  • Close personal understanding of the gay community

There have been big shifts in how HIV prevention is understood within the sector and the public health system.  Australia’s first national HIV strategy talked extensively about education, but by the third release of the strategy, it was talking about health promotion reflecting the slow diffusion of the impact of the Ottawa Charter for Health Promotion (WHO, 1986).  In 2004, I was a project worker in a position called Health Educator in a team called Health Promotion.

There have been further changes, such as a further shift in the self-concept of prevention work from health promotion to public health. At the recent AFAO Gay Men’s HIV Education conference in Sydney, I met gay men who’d done Masters in Public Health degrees before coming to work in gay men’s health, and many of them were excited about some pretty mundane ‘technological innovations’.  (Popup ads on Grindr — high tech shit.) My concern is that, along the way, many of the good things about adult education have been lost from our collective understanding of how HIV prevention works.

In the same time period, Australian society has become markedly less progressive, particularly around sex.  No, not sexuality, if you understand that as a reference to sexual orientation rather than ways-of-being-sexual.  As gay identity has become more and more acceptable, there has been an increasing level of comfort talking about what kind of sex gay men shouldn’t be having, and dis-comfort around what kinds of sex gay men are actually having.  For example, there has been extensive mainstream news coverage ‘othering’ barebacking — unprotected anal sex — as something the ‘bad gays’ do and the ‘good gays’ (the ones who get married) apparently don’t.

Similarly, there have been media panics around the increasing uptake of heterosexual anal sex and decreasing age of first sex and increased access to porn via the Internet and apps and increased use of online and mobile dating services and sex work and surrogacy as human trafficking.  *deep breath*

One bright spot has been the emergence of feminism as a viable alternative body of thought for social criticism to fill the void left by Marxism.  I’m not wild about the literalism of ‘feminism=for women’ that informs splitting Daily Life from the Fairfax online properties, particularly since those properties have become increasingly un-feminist in their coverage.  But it has had an undeniable influence on public debate around the deaths of Jill Meagher and Traci Connelly and the need for wide-scale feminist law reform.

There have also been feminist positions taken against sex work, against pornography, against casual hookups, against stripping, against pole-dancing, against, well, sex itself.  They have gone hand in hand with social conservative and Christian positions dating back to the Howard government that went more or less unchallenged under Rudd and Gillard.

All of this makes sex-positivity an increasingly challenging position to take.

During the week, the Burnet Institute did a press release that got a heap of coverage.  It was for two conference presentations.  It summarised multiple years of surveys at the Big Day Out.  Across the different time points, the average age of first sex got younger.  The researchers speculate this is attributable to increased exposure to pornography:

One potential explanation for a historical decrease in AFS is the increasing role of the media in creating a ‘sexualised’ culture, and its use as a sexual education and empowerment tool for young people. Young people surveyed at the Big Day Out in 2012 stated that they were equally comfortable sourcing sexual health information from both a website and a doctor. Sexualised content such as pornography has become normalised in today’s society, and provides a private and easily accessible way for young people to learn about sex and sexual norms. Furthermore, in a study by Brown et al., early exposure to sexualised content predicted oral sex and sexual intercourse (Vella et al, 2014, citations omitted).

There are so many things wrong with this.

*        *        *        *        *

At this point I want to take a detour for a moment and talk about research practice and policy discourse.

Previously I’ve written here about how public health as a practical discipline tends only to be informed by a couple of social scientific disciplines: epidemiology and psychology.  Social public health refers to a form of public health practice informed by a broader palette of knowledge practices, including sociology, anthropology, cultural studies, etc (Kippax & Race, 2003).

From pretty early on in the HIV response in Australia, prevention was informed by a multi-disciplinary social public health approach.

More recently though, I was at a conference in social research and saw postgrad students doing things like lumping together all Asians into one category because there were too few of them to analyse statistically in separate groups based on country of origin.  Sure, you can get results from that, but what would you do with them?  Make a campaign poster in Chinese Restaurant Menu font to signal ‘hey, Asians, we’re talking to you’?

At that research conference I really appreciated when a senior colleague, a sociologist, fired up and pointed out the problems in that classification.  It scared the living hell out of the postgrad student, but I wondered why nobody had pointed this issue out to them.  The answer was, probably, there’s a growing divide in many research centres between quant people and qual people, positivist and critical theory perspectives.  Projects in which these disciplines actually converse, rather than work side-by-side, are getting rarer than before.

As well, what the quant people recognise and the qual people often don’t is that low quality research can nonetheless (a) get published, obviously and (b) exert considerable policy influence just because it’s simple.  When it gets passed up through the hierarchy at a health department for sign-off, it all gets reduced down to a single page memo, so insisting on nuance/complexity can be a liability.

If a senior policy officer were writing up the findings of that postgrad student’s research, they might not even put “Asian” into that memo.  It might come out saying “cultural diversity”, because in policy language specific detail is dangerous.  The more specific it is, the smaller the group affected, the more it looks like special treatment, the harder it is to fund.

Policy is another discourse that has infected strategy-writing in Australia’s BBV responses.  In my contribution to a working group writing Australia’s testing strategy for hep B, a condition that overwhelmingly affects migrants from countries where infant vaccination isn’t universal, I had a massive fight on my hands to get specific detail about cultural safety, use of interpreters, and relevant cultural understandings into the final document.

The problem is partly about policy people hating specific details and partly about educated middle-class white people feeling uncomfortable with the symbolic violence inherent in producing knowledge about non-white people…. as if that discomfort ethically outweighs the imperative to prevent non-white people dying from hepatitis B related liver cancer.

*        *        *        *        *

I think that squeamishness is similar to what George Lakoff is describing in the quote that opens this post, and a similar kind of squeamishness is holding smart, progressive, sex-positive people back from adding their voices in a robust manner to media discourse about sex.

During the week, I received an e-mail asking if I knew anyone who wanted to comment on the ‘early first sex’ paper, for a short news article exploring whether the same applies to same sex attracted young people.  I replied saying no thanks, but hey, maybe someone could mention ‘sensation seeking‘ as a personality trait that predicts both porn use and early first sex.

I got an e-mail back from a senior colleague, someone I trust and respect, saying ‘you should be very cautious because the concept of sensation seeking is subject to contestation’.

There is nobody I would trust more to give me a run-down on how a particular concept or theory was problematic for academic use.  But I want to spell out here why I think that concern for fidelity to the complexity and history of social scientific debates sometimes backfires when it comes to media engagement.

In a short news article, the genre conventions rule. You’ve got one sentence to meet the journo’s brief — in this case, yes/no, does the finding apply to same sex attracted kids?

And, if you phrase it really well, you can get another sentence or two, towards the end of the article, to, as they say in politics, ‘put a context around’ the initial findings.  It could go something like this:

There are personality traits that make some people more likely to attend a music festival, take drugs, use porn and have earlier sex than the rest of their cohort.  The initial findings are interesting but we would like to see the research explore those possible confounding factors.

As someone originally trained in cultural studies, one of the more challenging things for me about the social psychological literature on HIV prevention is what we could call its naturalistic epistemology — the idea that phenomena like porn exist in an external, objectively measurable reality, as things with causal influences in their own right.

Like any cultural product, the effect of porn is necessarily mediated by what we call active reception by the audience.  The mimetic or ‘monkey see monkey do’ theory of media effects has been thoroughly discredited, but how many epidemiologists — like the crew at Burnet — are reading books and papers in media and communication studies?

Even journalists — who probably do have some exposure to this research — would face an impossible task trying to render these complexities in a 600 word news piece.

So to combat sex-negative crap like ‘porn is making teens have sex earlier’, psychological concepts with their technical-sounding names and plain English definitions and above all, their naturalistic epistemology that matches that of journalism, are often the best resource to draw on.

When Dr Megan Lim from the Burnet Institute was interviewed on Radio National, she said:

“People who watched pornography more often were more likely to have sex without condoms, more likely to engage in behaviours like anal intercourse, and also to have sex at a younger age. But, I guess, from this study, we definitely can’t conclude that pornography is a causal factor, just that the two behaviours are correlated.”

The interviewer James Carlton went straight to the point:  “And if it’s not a causal factor, what might be the factors behind its correlation?”  In response Dr Lim made the point where sensation seeking is relevant:

“Yeah, well, I think probably just the fact that people who are more sexually aware, sexually developed, more interested in sex are those that are more likely to watch pornography and also the ones who are more likely to engage in sexual behaviours.”

Sensation seeking is a useful concept there because it makes the story about diversity among individuals, whereas a conservative Christian school board member listening to that interview could have easily concluded that comprehensive sex education is what leads to young people being “more sexually aware, sexually developed, more interested in sex”.

*        *        *        *        *

Simplistic, sensationalist, sex-negative ‘findings’ get extensive media coverage and three years later somebody writes a smart, sensible book or discourse analysis in academic language in a peer reviewed publication and nobody in the news media, the policy or mainstream communities ever gets to hear about it.

Sex-negativity wins in a default because the sex-positive advocates are too afraid to show up.  Or worse, we get represented by counsellors who do most of their work with people having problems and that becomes the narrative. Rather than sensation seeking — a curious, exploratory, energetic drive — we get stories about sexual compulsivity and porn addiction.

I wrote the paragraph above on Friday, and on Saturday I found this article about porn addiction by Julia Medew (of course) in The Age (of course).  Some experts estimate… some doctors believe… a growing number of sexologists have reported…  This is a Fox News version of health reporting.  All the ingredients you need to write that story are there:

  • A factoid: one in ten people who use porn becomes addicted, apparently.
  • Some human colour: “Like most men, Hugh Martin’s first encounter with porn was accidental.”
  • An expert opinion: “A leading sex therapist” says “I believe the brain is plastic”.

For all we know, Medew shopped around any number of academics looking for a quote to fit her hackneyed angle, and all of them, perhaps wisely, refused to provide one, or gave one that didn’t fit the narrative and so didn’t get a mention.

For academics, engaging with the media around sex and sexuality must be incredibly frustrating.  There is no shortage of really shitty reporting about sex.  The challenge calls to mind a distinction made by de Certeau: elites have strategy, the rest of us have only tactics.  There is no ‘media strategy’ that will, once and for all, ‘address the problem’ of sex-negative media coverage.  That’s wishful thinking.

Instead, it’s like one big game of whack-a-mole, slapping down crappy articles with whatever works in the moment.  Thank goodness there’s nothing really serious at stake — just the future of comprehensive sex education in schools and policy support for frank, sexy HIV prevention campaigns.  It’s a game we need to get good at, and that will only happen when we get out on the field.

Are you a sexual racist? Article from 2003.

An article in the Daily LifeI only date hot white girls” prompted me to dig out this post from way back.  I wrote this back in 2003 as a volunteer for the Victorian AIDS Council for its regular column “ComMENts” in the gay paper MCV.  The following year I went to work for the AIDS Council in an HIV prevention role.  I recently celebrated my tenth year in HIV work, but it was actually a concern for sexual racism that led me into gay men’s health promotion.  This is one of a series of pieces I refer to in a recent post on Croakey, co-authored with Suzanne Nguyen, about defining everyday racism.

Sexual Racism. Is it a real problem or just activism’s latest buzzword? Are you a sexual racist?

Sexual racism is hard to see at first, because it looks just like personal sexual preference, and we’ve been fighting for freedom there for decades. So when someone says ‘I’m just not attracted to Asians’, is that privileged speech that is immune to criticism? Maybe not.

The rumblings started online with the ‘Sexual Racism Sux’ (SRS) campaign launched last year [2002] by three Sydney activists, targeting chatrooms and personals and the exclusionary language you can find there. ‘No GAMs’, or ‘No GAMs, Fats or Femmes.’ Online it’s easy to say stuff you’d never dare say in ‘real life,’ but the effect it has is real.

The SRS Campaign doesn’t argue that guys who ‘prefer’ only GWM’s are racist. Instead it criticises exclusionary expressions of sexual preference: ‘We’re not saying you’re supposed to change your preference,’ says Peretta Anggerek, ‘We’re just asking for people to be decent.’ That sounds fair enough, when ‘I prefer Caucasians’ will do the trick.

Already a ‘Freedom 4 Gays’ counter site has been set up to attack the SRS-ers as ‘sexual nazis’, ridiculing the idea that net users should say what they’re looking for instead of who they refuse to consider. ‘Freedom 4 Gays’ writes, anonymously, that he’d have to list every single nationality except the Asian ones. But if he’ll consider anyone but an Asian person, it’s not hard to call him a sexual racist.

The real question is difficult: is the problem the expression or the exclusive preference itself? The exclusive preference has all sorts of nasty power effects. It isolates non-white people as the objects of a racial fetish. It creates small racial ghettoes where the scarcity of the few white guys who’ll date non-white guys inflates their market value, and the dating power that goes with it. It reduces the pool of potential friends and playmates: if you’ve ever felt the scene was too small, this is one reason why.

Expression matters, too. Culture is the collective sum of our attitudes and interactions, so tact and positive expression make for a kinder culture. We live everyday with the alternative: men insisting on their rights, especially their right to denigrate others, and it has a real effect on community health. Depressed individuals are more likely to engage in risk-taking and self-harming behaviours, like unsafe sex.

In a broader sense it creates a divided and stratified community obsessed with policing the borders of each little social niche. Sexual racism re-marginalises people who have already been marginalised by their ethnic communities because of their sexuality. It’s pure hypocrisy to call for acceptance and understanding of sexual difference, then to deny the same to people of different cultures.

Many guys do already advertise their preference in positive terms, saying ‘I prefer’ instead of ‘not into.’ Racially exclusive sexual preference may be something that only diminishes over time, in a generation or two. The first step, a step we can take now, is to recognise the exclusive attitudes that deter and discourage baby queers from considering anyone except white guys as attractive and as full sexual citizens. In the meantime, you don’t need to want to fuck someone to treat them with respect.

Cultural and environmental factors are difficult to change, but cultures change when enough individuals do. The bitchiness, emptiness and hell, the boringness of the scene – and we’ve all felt it – have a lot to do with the people it excludes, and our fear that one day we’ll be excluded, too. (Anyone here afraid of ageing?)

The SRS campaign doesn’t ask people to take personal responsibility for the racism of our whole culture – only for the part their expressions of sexual preference can play in it. Even if you disagree with the concept, giving thought to it is a good start.

Author note: Since writing this my position has actually shifted; I’m now a lot more inclined to argue that we should take personal responsibility for the racism of ‘our’ (by which at the time I meant ‘white Australian’) whole culture.  As I’ve moved from activism into health promotion practice and now social research, I’ve become a lot more interested in arguing that the system of preferences itself is racist, not just the way those preferences are expressed.  Also, this was clearly written before I worked in HIV prevention — people who live with depression are sometimes more likely to take risks and other times less likely; it’s not the slam-dunk predictor of HIV infection that my statement here suggests it is.

What do you think?  I welcome constructive responses in the comments section below.  You can also reply to me directly at

Sunday Snippets

I’m up at the orsm Jonas family’s farm with an incredible bunch of likeminded foodie lefty people.

Sky love at Jonai Farms

A photo posted by Daniel Reeders (@onekind81) on

Beatrice and piggehs

A photo posted by Daniel Reeders (@onekind81) on

I’m up here with the fabulous Linda Kirkman — researcher of friends with benefits relationships among rural heterosexuals over 50, and earlier in her life, Australia’s first surrogate mother.

Here she is in yesterday’s Good Weekend:

I'm spending the day exploring Bendigo with a celebrity!

A photo posted by Daniel Reeders (@onekind81) on

Here’s a video interview I did at the AIDS2014 conference with Rex Pilgrim from ACT UP Queensland.  We talk about the three main responses to the media panic about deliberate HIV infection — the criminal law, public health management, and a supportive community response.

Lastly, I got to co-author an article with the incredibly talented Suzanne Nguyen — artist, designer, story collector and provoker of thoughtful conversations about the modern reality of race in Australia.  For Croakey, the Crikey health blog.

Click to visit:  Defining and responding to everyday racism